Provider Demographics
NPI:1073764023
Name:TANBAKUCHI, BIJAN (AP)
Entity Type:Individual
Prefix:MR
First Name:BIJAN
Middle Name:
Last Name:TANBAKUCHI
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 KAIOO DR APT A409
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-5816
Mailing Address - Country:US
Mailing Address - Phone:808-630-9339
Mailing Address - Fax:
Practice Address - Street 1:3660 WAIALAE AVE STE 305
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3259
Practice Address - Country:US
Practice Address - Phone:808-942-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU931171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist